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General NPI Number Information
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NPI Number | 1164563243
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Entity Type | Organization
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Legal Business Name | PONCE CLINICAL LABORATORY, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 609 TITO CASTRO AVE SUITE 101
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-841-4846
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Fax | 787-841-4846
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Provider Business Mailing Address
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Address Line | 609 TITO CASTRO AVE SUITE 101
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-841-4846
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Fax | 787-841-4846
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GRYCEL ROSADO SANTIAGO
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Credential | M.T.
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Telephone | 787-841-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 273
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License Number State | PR
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